İleri yaş deplase femur boyun kırıklarının tedavisinde hemiartroplasti ve total kalça artroplastisinin karşılaştırılması
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Date
2017
Authors
Barışhan, Fatih Canşah
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Publisher
Uludağ Üniversitesi
Abstract
Amaç: Çimentosuz hemiartroplasti yada total kalça artroplastisi (TKA) ile tedavi edilen ileri yaş deplase femur boyun kırıklı (FBK) olgularda klinik ve radyolojik sonuçların karşılaştırılması ve seçilen tedavi yönteminin morbidite ve mortalite üzerine etkisinin değerlendirilmesi amaçlandı. Gereç ve Yöntem: Deplase FBK nedeniyle çimentosuz hemiartroplasti (Grup I) ya da TKA (Grup II) uygulanılmış ileri yaşta (>65) hastalar geriye dönük değerlendirildi. Cinsiyet, ASA skoru, ek hastalık sayısı, travma-kırık tipi, Sportorno indeksi, ameliyat sırası-sonrası kanama- transfüzyon miktarı, hemoglobin düşmesi, ameliyat süresi, yatış süresi, izlemlerdeki Harris kalça puanı, radyolojik değişiklikler, Barthel aktivite skoru, gelişen komplikasyonlar ve Carlson komobidite indeksi ile ilişkisi ve erken dönem ve son izlemlerdeki mortalite oranları gruplar arası karşılaştırıldı. Bulgular: Grup I'deki 22 olgunun yaş ortalaması 76.9 yıl (65-88) ve ameliyat sonrası izlem süresi ortalama 31 ay (16-47) iken Grup II'deki 16 olguda bu değerler 73.6 yıl (65-90) ve 30.5 aydı (16-48) (p>0.05). Grup I ve Grup II klinik ve radyolojik sonuçlarda fark tespit edilmedi (p>0.05). Grup I'de Harris puanı ortalama 83.9 (75-97) ve Grup II'de 83.3 (71-93) idi (p>0.05). Grup II de kanama ve transfüzyon miktarı daha fazla idi (p<0.05). Komplikasyon ve morbidite oranları ise benzerdi (p>0.05). Mortalite oranları Grup I ve Grup II için sırasıyla 1. ayda %4.5 ve %6.3 ilen son izlemlerde %18.2 ve %25 idi (p>0.05). Sonuç: İleri yaşta gelişen deplase FBK'nın çimentosuz hemiartroplasti ve TKA ile tedavisinin kısa dönem klinik ve radyolojik sonuçları benzerdir. Mortalite ve morbidite oranları ek sistemik hastalıkların varlığıyla ilişkilidir.
Objective: To compare clinical and radiological outcomes based on mortality and morbidity in elderly patients with femoral neck fractures who underwent cementless hemiarthroplasty or total hip arthroplasty (THA). Material and Method: Cases of displaced (Garden type 3-4) femoral neck fracture in the elderly (>65 years) treated with cementless hemiarthroplasty (Group I) or THA (Group II) were analyzed retrospectively. The groups were compared in accordance with their sex, ASA scores, additional systemic diseases, type of trauma-fracture, Spotorno index, preop-postop bleedingtransfusion amount, decrease in haemoglobin concentration, duration of operation, length of stay, follow-up Harris Hip scores, radiological changes, Barthel activity scores, developed complications, Charlson comorbidity index relationship, and early and late follow-up mortality ratios. Results: The 22 cases in Group I had an average age of 76.9 years (65-88) and had been monitored for 31 months (16-47), while in Group II, the 16 cases had an average age of 73.6 years (65-90) and monitoring time of 30.5 months (16-48) (p>0.05). Differences in clinical and radiological parameters between groups (p>0.05) were not significant. The Harris scores were 83.9 (75-97) in Group I and 83.3 (71-93) in Group II (p>0.05). In Group II, the amounts of bleeding volume and blood transfusions were significantly higher (p<0.05). Complication ratios and morbidity ratios were similar in both groups (p>0.05). Mortality ratios in Group I and Group II in the first month were 4.5% and 6.3%, and at the last follow-up were 18.2% and 25% respectively (p>0.05). Conclusion: Displaced femoral neck fractures treated with cementless hemiarthroplasty and total hip arthroplasty in the elderly have similar shortterm clinical and radiological results. The main determinant of morbidity and mortality ratios is the presence of an additional systemic disease.
Objective: To compare clinical and radiological outcomes based on mortality and morbidity in elderly patients with femoral neck fractures who underwent cementless hemiarthroplasty or total hip arthroplasty (THA). Material and Method: Cases of displaced (Garden type 3-4) femoral neck fracture in the elderly (>65 years) treated with cementless hemiarthroplasty (Group I) or THA (Group II) were analyzed retrospectively. The groups were compared in accordance with their sex, ASA scores, additional systemic diseases, type of trauma-fracture, Spotorno index, preop-postop bleedingtransfusion amount, decrease in haemoglobin concentration, duration of operation, length of stay, follow-up Harris Hip scores, radiological changes, Barthel activity scores, developed complications, Charlson comorbidity index relationship, and early and late follow-up mortality ratios. Results: The 22 cases in Group I had an average age of 76.9 years (65-88) and had been monitored for 31 months (16-47), while in Group II, the 16 cases had an average age of 73.6 years (65-90) and monitoring time of 30.5 months (16-48) (p>0.05). Differences in clinical and radiological parameters between groups (p>0.05) were not significant. The Harris scores were 83.9 (75-97) in Group I and 83.3 (71-93) in Group II (p>0.05). In Group II, the amounts of bleeding volume and blood transfusions were significantly higher (p<0.05). Complication ratios and morbidity ratios were similar in both groups (p>0.05). Mortality ratios in Group I and Group II in the first month were 4.5% and 6.3%, and at the last follow-up were 18.2% and 25% respectively (p>0.05). Conclusion: Displaced femoral neck fractures treated with cementless hemiarthroplasty and total hip arthroplasty in the elderly have similar shortterm clinical and radiological results. The main determinant of morbidity and mortality ratios is the presence of an additional systemic disease.
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Keywords
Hemiartroplasti, Total kalça artroplastisi, Femur boyun kırıkları, Komorbidite faktörleri, Mortalite, Hemiarthroplasty, Total hip arthroplasty, Femoral neck fractures, Comorbidity factors, Mortality
Citation
Barışhan, F. C. (2017). İleri yaş deplase femur boyun kırıklarının tedavisinde hemiartroplasti ve total kalça artroplastisinin karşılaştırılması. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.